Wednesday, April 13, 2022

Smart Sense: Managing Pain Holistically

Thanks in part to the web-driven information age, today's educated consumer holds the advantage of some of the fastest research technologies and complete global access to the vast majority of health protocols and treatment modalities available.  This forged our personalized culture where optimal info access and the freedom to decide between many diagnostic and therapeutic principles helps us go beyond the TRADITIONAL (or conventional) medicine.  The Integrative Pain Healers Alliance (IPHA) is committed to exploring all areas of health from current experts, researchers and educators.  We start our report with a popular injury called Plantar Fasciitis. We are fortunate to encounter a specialist in HOLISTIC PODIATRY to shed light on a whole-body approach to healing this commonly painful disorder. Dr. Robert Kornfeld offers his successful strategy to fulfilling what many would consider a 'healthier and more intelligent way' to therapy by combining convention with complementary and alternative medicine.


When considering any inflammatory pathology like plantar fasciitis, it is important to not only look at the tissues in pain and make a diagnosis, but it is equally important to understand the mechanisms behind the pathology. In so doing, we need to understand our patient as a unique being and not fall into the trap of treating every patient with plantar fasciitis in the same way. Many patients can develop plantar fasciitis but can have completely different mechanisms that make it difficult for the immune system to heal the injured tissue.

In my world, the world of functional medicine, we need to examine 2 issues before we get into healing the plantar fascia. Number one is we must look at the patient’s BIOMECHANICS, i.e., the structural and functional contributions to the problem. This may be congenital structural issues or problems with the functional aspects of walking and running. It can be poor training, over-training, tight muscles due to lack of stretching, improper footgear for that particular patient’s needs or the necessity to manage these issues with a prescribed, custom molded orthotic device.

Many patients will heal by correcting these biomechanical contributors to the dysfunction which cause the injury to the plantar fascia. But many will not. In those patient’s it become necessary to look at the immune system which is tasked with the job of repairing injured cells. So the second thing we turn our attention to is to discover what burdens there are on the immune system that are making it inefficient and not enabling the healing of the injury. For that, we need to take a patient-specific approach to the epigenetics (diet, lifestyle and environmental issues). The most common things we look for are:

- Poor nutrition/food quality

- Lack of adequate hydration

- Adrenal stress/Neurotransmitter imbalances

- Detoxification disorders

- Hormonal changes

In addition, we must look at what is involved in healing. The plantar fascia, being a connective tissue, receives its blood flow through microscopic blood vessels, not large arteries. In our modern society, we are dealing with many chronic stressors that can lead to adrenal/neurotransmitter imbalance. If there is an excitatory neurotransmitter dominance, we see microscopic blood vessels go into spasm. This is a primitive survival mechanism designed to shunt blood from the extremities and send it to the heart for increased blood flow to the upper arms and legs to either fight the beast that wants to eat us or run away from it. Correcting these chemical imbalances can alter the rate of perfusion into these tiny vessels in order to deliver the necessary substrates of healing.  

Once all of these mechanisms have been diagnosed and addressed (obviously in patients who do not respond to conventional treatments), then we can begin to foster the healing of the tissues. I utilize regenerative medicine which are medicines that stimulate more efficient repair and message the immune system to release protection and open the pathways that can repair the injured cells. This is health promoting instead of using drugs with side effects that interfere with normal physiology.

To that end, I use homeopathic injections, prolotherapy, PRP or amniotic allograft injections. There are different reasons why I choose different approaches but it is all patient-specific. Regardless of the chosen therapy, they are all designed to get the immune activity focused on healing and repair and not on protection. In this way we heal patients AND we leave then healthier than when they first came to see us.

DR. ROBERT KORNFELD has been practicing podiatric medicine and surgery for over 40 years. After training in traditional medicine and surgery, Dr. Kornfeld sought to answer a very important question - why does this specific patient have this diagnosis? He knew that finding the underlying mechanism to the presenting pathology was the critical issue that traditional medicine was not addressing. This naturally brought him into the field of holistic medicine. His dedication to treating chronic foot and ankle pain at its source has given him well-researched insight into how the human body manages cellular injury that it is unable to repair so he can alleviate chronic pain syndromes that have resisted traditional medical approaches. Dr. Kornfeld has offices in New York City and Port Washington, Long Island. (

The research benefits of using ultrasound scanning in therapeutic monitoring allows for tremendous flexibility in exploratory detection. Once we have established the initial Base Line of the ‘before and after’ scan, having probe in hand empowers the diagnostician to go deeper and wider- allowing for more answers and possibly finding other pathologies.   After we looked at the obvious muscle abnormality, the question is to go back and see what's causing the problem. Upon observing what’s under the white skin area, there appears a very thick white band (FASCIA covering the muscle) between the two dark layers of the subcutaneous fat and the muscle.  We notice that the fascia splits into two levels with the upper arrows, denoting the top part of the split and the lower arrows showing the bottom part of the split. The black area in the split is filled with fluid indicating the fascia lining is abnormal and this is a way that we can follow the cause for the muscle irritation in future tracking.  (see complete article & video)

by: Josh Tiberius Schueller, PT

Plantar Fasciitis is a challenging, difficult and often time frustrating injury that effects millions of people per year. PF is not considered a serious injury on the spectrum of musculoskeletal injuries so there have been a lack of attention to effective treatments. Many suffers are active competitive people who struggle with the lack of effective treatment. These people have to take weeks into months off from training because of this injury. Traditional treatments have been lackluster in results which has spawned “gimmicky” devices that have flooded the market. The need for a safe, effective treatment for PF is apparent. These devices need to be validated to decrease consumer fraud. The health care professionals need to realize that traditional treatments of ice, rest, and immobilizing are not effective for active people. (see full article)

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